PICC LINES / IV ANTIBIOTICS
Updated: 22 hours ago
Christina and I both had stomach issues, so our doctors felt it necessary to do this approach to drive down the infections so that we could get to a natural protocol. Many do just fine without needing this approach.
"I had a PICC line for about 7 months and it helped tremendously. Please know that you need to learn about how to keep it clean and flushed. I found a PICC line cover to be very helpful."
-Christina
"This option isn't for everyone, but some Lyme patients end up needing this route. I personally had PICC lines for 18 months. Other than that, I have used all natural treatments with success and continue to heal. I have no regrets."
-Jessica
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
WHAT IS A PICC LINE?
- PICC is short for peripherally inserted central catheter. It's a long, thin, soft tube placed in a vein in the upper arm, with its tip resting in a large vein near the heart.
- It's used when someone needs IV medicine for a long stretch of time. It can also be used for blood draws.
- Placing it usually starts with a numbing shot, which may sting for a moment. Ultrasound is often used to find the vein and guide the line, and an X-ray may be done to make sure the tip is in the right spot.
- In her guest post on LymeDisease.org, Hannah Barry shared that the numbing shot was the worst part for her, and that she felt sore afterward. A home nurse then came once a week to change her dressing.
WHY SOME LYME-LITERATE DOCTORS USE IV ANTIBIOTICS
- ILADS stresses that chronic Lyme needs a treatment plan made for each person, and that people with disseminated (spread-out) Lyme may need longer courses and combinations of antibiotics.
- ILADS's treatment guideline lists IV ceftriaxone (Rocephin) or Bicillin shots as options when someone has serious symptoms, has had little or no response to earlier treatment, or is getting worse. ILADS rates the research behind this as limited, so the choice is made person by person.
BICILLIN
- ILADS says IV antibiotics are a choice, made by weighing the risks and benefits for each person. When Lyme is badly affecting someone's quality of life, ILADS says IV treatment may be completely appropriate.
- Global Lyme Alliance writer Jennifer Crystal, who had a PICC line for a year, explains that Lyme-literate doctors often recommend IV antibiotics for late-stage Lyme, when the infection has spread through the body and often into the nervous system.
- Stomach issues are another reason, like for Christina and me. IV medicine doesn't go through the gut. In a 2024 report, Dr. Richard Horowitz described a patient who had been switched from oral to IV antibiotics, partly because the pills upset her stomach.
WHAT THE RESEARCH SHOWS
- Two of the four NIH-funded US trials of retreating chronic Lyme (2001 to 2008) found IV ceftriaxone helped on some of the measures studied, ILADS and Dr. Horowitz note.
- In one of those trials (2003), 64% of people with severe fatigue improved in a meaningful way after 28 days of IV ceftriaxone, compared with 18.5% on placebo.
- In another (2008), people on 10 weeks of IV ceftriaxone did somewhat better on thinking and memory tests shortly after treatment than those on placebo, but the difference didn't last to 14 weeks after treatment. Those who started out with more pain or physical limits seemed to keep more improvement in those areas.
- A 2011 study by Dr. Raphael Stricker and colleagues followed 158 people with neurologic Lyme on IV ceftriaxone for up to a year. Fatigue, brain fog and muscle aches improved, with the biggest gains in those treated 25 to 52 weeks. There was no comparison group, so more research is needed. Part of the funding came from a private company, QMedRx, where one author worked.
- Treatment keeps changing. In a 2024 report of three patients, Dr. Horowitz found that short, pulsed combination therapy aimed at persister forms (including dapsone) helped more than the oral, shot or IV antibiotics they had tried before.
DAPSONE
POSSIBLE BENEFITS
- IV medicine skips the stomach, which may take pressure off the gut.
- Jennifer Crystal shares that IV antibiotics may work faster than pills, and she felt her recovery was quicker for it.
- More medicine choices. Some antibiotics work better by IV, which gives your doctor another option, for example when progress has stalled.
- A home nurse often checks the line and draws labs, so your doctor can keep an eye on how your body is handling the medicine. Many people, like Jennifer and Hannah, learn to do their own infusions at home.
POSSIBLE DOWNSIDES AND RISKS
- Stronger herx reactions. Because more medicine gets in faster, die-off can hit harder. Some doctors give a few days off to let the body catch up.
- Gallbladder problems. Ceftriaxone (Rocephin) can cause gallbladder trouble in some people. Some Lyme-literate doctors check labs often and add a prescription to help protect the gallbladder.
WARNING if you use Rocephin (aka Ceftriaxone)
- Line problems, mainly infections and blood clots. In the four NIH trials, ILADS counted 7 serious line-related problems among 221 people (4 infections, 2 clots and 1 clot in the lung).
- In a 2025 University of Michigan study of people getting IV antibiotics at home after a hospital stay, serious line problems (a bloodstream infection or a clot) happened in 3.4% of those with PICC lines. These were mostly older patients on shorter courses, not Lyme patients.
- Allergic reactions to the medicine can happen. In the NIH trials, 6 of 221 people had one.
- Daily life changes. The line has to stay dry (no swimming), and you'll need to protect it from snagging.
- Cost and insurance. Getting IV treatment approved can take work.
HOW TO NAVIGATE THROUGH INSURANCE DENIALS AND GET YOUR DOCTOR'S ORDERS APPROVED
OTHER OPTIONS TO ASK YOUR DOCTOR ABOUT
- Pulsed IV. Dr. Joe Burrascano, one of the founders of ILADS, explains that with IV given two days a week, a short line can be placed in the arm and taken out afterward, instead of a PICC. That means more than half the week with nothing in the vein to clot or get infected, and less strain on the gut and gallbladder.
- A midline. This shorter line ends in a vein in the arm instead of near the heart. In the 2025 Michigan study, midlines had fewer serious problems than PICC lines, especially for courses of 14 days or less. Midlines are generally meant for shorter courses and don't work for every medicine.
- Bicillin shots. ILADS notes that these shots into the muscle avoid the risks of an IV line.
CARING FOR YOUR PICC LINE
- Your nurse will show you how to flush the line, change the dressing and give your medicine. It helps to have a family member or friend learn it with you.
- Keep it clean. Wash your hands well (about 30 seconds) before touching the line, and wipe the end of it with an alcohol or chlorhexidine wipe before each use. Don't touch the spot where the line leaves your arm.
- Keep it flushed. Flush it after every use, exactly as you were taught. This keeps it clean and helps stop clots from blocking it. Push slowly and never force it.
- Keep the dressing fresh. It's usually changed about once a week, often by your home nurse, and sooner if it gets loose, wet or dirty. Look at the skin around it for redness, swelling, bleeding or drainage.
- Keep it dry. There are options for protection during the day. You must keep lines secure and dry. Nurses will provide a netting type option as well for you.
- This is the one that worked best for me in the shower: a LimbO waterproof cast and dressing protector, a sleeve that slides over the arm to keep the line dry. Keep your arm down while showering. Others I bought leaked, and you must keep it dry.
- Keep the clamps closed except when you're using the line.
- Check your temperature daily at about the same time, and keep a log.
- Go easy on that arm. MedlinePlus suggests no lifting with it and no hard activity for about 2 weeks after the line goes in.
CALL YOUR DOCTOR OR NURSE IF YOU HAVE
- Fever or chills
- Redness, swelling, bleeding or drainage where the line goes in
- Swelling, pain, warmth or redness in that arm, or pain in your neck, face or chest. Swelling in the arm can be a sign of a blood clot.
- Trouble flushing, or the line seems blocked
- Leaking, a cut or crack in the line, or the line starting to come out
- Dizziness
CALL 911 IF YOU HAVE
- Sudden shortness of breath or trouble breathing
- Chest pain, especially sharp pain that gets worse when you breathe in
- Coughing up blood
- Fainting, or a racing heart with dizziness
These can be signs of a blood clot in the lungs.
MY EXPERIENCE
- My whole treatment story, including my 18 months of IV antibiotics, is in my journey post:
MY JOURNEY
RELATED POSTS
PULSING ANTIBIOTICS
How on-and-off antibiotic schedules work and why some doctors use them:
ANTIBIOTICS - WHY USING ONLY ONE IS NOT RECOMMENDED IN CHRONIC LYME
Why most Lyme-literate doctors use more than one antibiotic:
https://www.riseabovelyme.com/post/antibiotics-why-using-only-one-is-not-recommended-in-chronic-lyme
SOURCES
ILADS, Lyme Disease Basics for Providers (2026)
ILADS, Cameron, Johnson and Maloney, Evidence Assessments and Guideline Recommendations in Lyme Disease (2014, older source, still worth reading)
Dr. Richard Horowitz and others, case reports, Microorganisms (2024)
Bay Area Lyme Foundation, Dr. Joe Burrascano: A Masterclass on Tick-Borne Illness (2025)
Global Lyme Alliance, Jennifer Crystal, Intravenous Antibiotics for Lyme: Pros, Cons, and the Lived Experience (2020, older source, still worth reading)
LymeDisease.org, Hannah Barry, The Adventures of Getting a PICC Line (2016, older source, still worth reading)
Stricker and others, Benefit of Intravenous Antibiotic Therapy in Neurologic Lyme Disease, Int J Gen Med (2011, older source, still worth reading)
University of Michigan, Paje and others, Midline vs PICC for Outpatient IV Antibiotics, JAMA Internal Medicine (2025)
MedlinePlus, PICC - Insertion (2025)
MedlinePlus, PICC - Flushing (2026)
MedlinePlus, PICC - Dressing Change (2025)
MedlinePlus, Deep Vein Thrombosis (2025)
MedlinePlus, Pulmonary Embolus (2025)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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